With pressure on California's foster care system to curb the rampant use of powerful psych meds on children, concern is mounting about the doctors behind the questionable prescribing.

For months, the state has adamantly refused to release data that this newspaper sought to expose which physicians are most responsible. Now, in response to a request from state Sen. Ted Lieu, California's medical board is investigating whether some doctors are "operating outside the reasonable standard of care."

The action comes after this newspaper's investigation "Drugging Our Kids" revealed doctors often prescribe risky psychotropic drugs -- with little or no scientific evidence that they are safe or effective for children -- to control behavior, not treat serious mental illness. Many of these drugs are approved only for schizophrenia, bipolar disorder and other relatively rare mental illnesses.

Joymara Coleman, a 24-year-old Cal State East Bay student, displays two of the psychotropic medications she was prescribed while in foster care. (Dai Sugano/Bay Area News Group) (Dai Sugano)

To examine the problem, the newspaper spent nine months negotiating with the state Department of Health Care Services to release a decade of prescribing data that did not identify individual patients.

The numbers the state finally provided showed that almost 1 in 4 adolescents in the California foster care system have been prescribed psychotropic medications over the past decade. Of the children on medications, almost 60 percent are being prescribed antipsychotics, a powerful class of drugs with serious side effects.

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But the state continues to rebuff a request that would allow the public to examine exactly how many prescriptions for taxpayer-funded psych medications each doctor wrote. Instead, it lumped the prescribers into two groups -- those who wrote fewer than 75 prescriptions in a year; and those who wrote more than 75. Over the past decade, those lists show, 30 percent of the Medi-Cal prescribers wrote more than 75 prescriptions in a year, with 230 on the list last year alone. Under such an arbitrary measure, there's no way to tell whether a doctor wrote as few as 76 prescriptions or hundreds more.

The state-provided lists are also flawed. Sometimes the same doctor is listed in both the "under 75" and "over 75" categories; often, Walgreen's is listed as the prescriber.

The state contends it can only release the information in broad groups because it is trying to protect patient privacy. But patient advocates say the state is really shielding the offending doctors -- not the vulnerable children who have received the prescriptions.

Tony Chicotel, an attorney who has worked for four years to battle the overprescribing of psychotropic medications in nursing homes for the elderly, said he finds the state's refusal to turn over the prescriber information an outrage. Releasing information that could identify a patient -- like a name or date of birth -- would clearly be a privacy concern, Chicotel said.

"But just doctors prescribing pills?" he said. "We paid for it, so we have the right to know what our money's getting -- don't we?"

The Department of Health Care Services has repeatedly refused to say specifically how releasing the names of prescribers and numbers of prescriptions, with no patient information, would jeopardize patient privacy. On Wednesday, a spokesman responded in an email that his agency is upholding "its duty to protect the privacy of foster children."

In contrast, the news organization ProPublica successfully obtained prescribing data from the federal government about Medicare's prescription drug benefit, known as Part D, and now has a database of 1.1 billion prescriptions written by 364,000 providers. To protect patient privacy, Medicare removed some information when a provider wrote 10 or fewer prescriptions for a specific drug.

In a letter Monday to medical board President David Serrano Sewell, Lieu said he became concerned about the prescribers' role after reading this newspaper's "disturbing" report on Sunday. Lieu, D-Redondo Beach, chairs the committee that oversees the medical board, the state agency charged with protecting health care consumers by regulating licensed physicians.

Lieu's letter pointed to findings that doctors are prescribing drugs that have not been approved for children and that they are sometimes prescribing without reviewing the children's medical records or drug history. Lieu called on the medical board to come up with recommendations to minimize those "two dangerous practices."

"It doesn't seem that in every one of these cases there was a powerful reason to prescribe unauthorized medication to a child," Lieu said in an interview, referring to individual cases cited in the newspaper story. "There is a focal point for all of these cases -- there is a doctor, a prescriber who has to issue the prescription -- and it seems there's a breakdown at that point. And that's why I want the regulators to look into this situation."

Lieu said he is concerned there has been a breakdown in the trust of the "doctor-patient relationship" that all patients deserve. "You shouldn't be prescribing powerful psychiatric medications that are not approved for children," he said. "I'm not even sure what the reason for that would be to do that."

State Senate President Pro Tem Darrell Steinberg said in an interview Monday that he was also troubled by the newspaper's findings that show the state spends more on psychiatric drugs than any other type of drug for foster children -- more than $226 million in the past decade.

Steinberg, whose term ends this fall, urged the governor and Legislature to "do some serious oversight and make the overprescribing of psychotropic medications to foster youth a lead budget issue in the 2015-16 state budget."

In the meantime, Lieu is hoping for action from state regulators to rein in overprescribing. He said the medical board should look for "patterns among doctors that have been prescribing very high amounts of psychotropic medications to foster kids."

Lieu said he received a quick response from Sewell to his call for an investigation, with the California Medical Board president stating that "Drugging Our Kids" is "a troubling article and raises a host of important issues." Sewell vowed to look into the matter.

The medical board's executive director, Kimberly Kirchmeyer, also told this newspaper that her agency was taking the matter "very seriously" and had indeed launched an investigation.

News Research Director Leigh Poitinger contributed to this report. Contact Karen de Sá at 408-920-5781.